Susan Braddock

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Practice address

2009 Tremont Ave
Fort Worth, TX 76107-3959

Phone

(817) 395-6284

Fax

(817) 423-7734

NPI assigned

Jun 10, 2021

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bebd Telehealth

  • Clinic/Center
  • Fort Worth, TX
  • NPI 1730731688
  NPD Authorized official
• Bridgeside Telehealth

  • Clinic/Center
  • Fort Worth, TX
  • NPI 1861153785
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1623283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623283200000",
    "number": "1528635141",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2009 TREMONT AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761073959",
            "telephone_number": "817-395-6284",
            "fax_number": "817-423-7734"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2009 TREMONT AVE",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761073959",
            "telephone_number": "817-395-6284",
            "fax_number": "817-423-7734"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRADDOCK",
        "first_name": "SUSAN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-06-10",
        "last_updated": "2021-06-10",
        "certification_date": "2021-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lashunda Bracey
• Leslie Bracken, RD/LD
• Karen Brackett
• Michael Brackett
• Lindsie Brooke Bradberry
• Braden Partners LP
• Lorraine Simon Braden, LCSW, LMFT
• Dora Linda Bradford, RNC,BSN,WHNP
• Laura Ann Bradford, M.D.
• Emily Bradley, LPC

• Clinic/Center in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.